【摘要】 [目的]研究观察亚麻醉剂量艾司氯胺酮超前用药对老年患者全髋关节置换术后早期认知功能障碍（POCD）的影响。[方法]选择2020年1～7月,年龄65～89岁、ASA分级Ⅰ～Ⅱ、全麻下行全髋关节置换术患者60例,按照随机数字表法分为观察组和对照组（n=30）。观察组麻醉诱导前静脉注射0.2 mg/kg艾司氯胺酮,对照组给予等量生理盐水。记录两组患者术前（T₀）、切皮时（T₁）、手术开始后30 min（T₂）、拔管时（T₃）的平均动脉压（MAP）、心率（HR）。于T₀、术后24 h（T₄）、术后72 h（T₅）采用简易智能状态检查量表（MMSE）进行评分,同时采取患者颈内静脉血液标本检测神经特异性烯醇化酶（NSE）和S-100B血清浓度,观察并记录两组患者术后POCD发生情况。[结果]两组患者T₁、T₂、T₃的MAP、HR均较T₀显著升高（P<0.05）,但两组患者组间比较差异无统计学意义（P>0.05）;T₄时两组患者MMSE评分与T₀、T₅比较明显降低（P<0.05）,组间比较对照组显著低于观察组（P<0.05）;观察组T₄时POCD发生率显著低于对照组（P<0.05）;T₀、T₄、T₅时两组患者NSE血清浓度比较差异无统计学意义（P>0.05）;T₄、T₅时S-100B血清浓度较T₀时显著升高（P<0.05）,且T₄时观察组与对照组相比,S-100B血清浓度显著降低（P<0.05）。[结论]亚麻醉剂量艾司氯胺酮超前用药可安全用于老年患者全髋关节置换术,能够降低患者术后认知功能障碍发生率,改善其早期认知功能。更多还原

【Abstract】 [Objective]To investigate the postoperative cognition dysfunction（POCD） in elderly patients influenced by preapplication of sub-anesthetic esketamine alter total hip arthr-oplasty.[Methods]From the period of January 2020 to July 2020,60 elderly patients who were aged 65 to 89,classified Ⅰ to Ⅱ by ASA,and considered as candidates for an operation of total hip arthr-oplasty in HuaiheHospital of Henan University were selected and split intotwo groups,namely,the observation group and the control group（n=30）.The patients of the observation group were intravenously injected with esketamine 0.2 mg/kg while the patients of the control group were treated with saline of the same amount before anesthesia induction.The mean artery pressure（MAP）,heart rate（HR） of all patients at preoperation（T₀）,skin incision（T₁）,30 minutes after operation（T₂）,and extubation（T₃） were recorded.The minimum mental state examination（MMSE） was employed to mark at T₀,24 h（T₄） and 72 h（T₅） after operation,the neuron specific enolase（NSE） and S-100 B serum concentrations were detected by using the intracr-anial venous blood specimen of patients at the same time.Theincidence of POCD of the two groups after operation was observed.[Results]The MAP and HR collected at T₁,T₂,and T₃ were significantly higher than that of T₀（P<0.05） of the two groups,however the differences compared between the two groups were of no statistical significance（P>0.05）.The collected MMSE scores at T₄ of the two groups were found eminently lower-than the scores observed at T₀ and T₅（P<0.05）,and the score of the control group was also found to be much lower-than that of the observation group（P<0.05）.The recorded POCD incidence at T₄ of the observation group was discovered to be greatly lower than that of the control group with the differences statistically significant（P<0.05）.There was no noticeable change in the NSE serum concentration for both groups at T₀,T₄,and T₅（P>0.05）.The S-100 Bserum concentrations at T₄ and T₅ were prominently higher than that of T₀（P<0.05）,and the serum concentration of S-100 B at T₄ of the observation group was substantially lower than that of the control group（P <0.05）.[Conclusion] Preapplication of sub-anesthetic close esketanine was proved to be safely applicable for elderly patients undergoing total hip arthroplasty,which can reduce the incidence of POCD and improve their early cognitive function.更多还原